Provider Demographics
NPI:1275211856
Name:WHITE, MOLLY MICHELLE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 SIOUX CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2147
Mailing Address - Country:US
Mailing Address - Phone:904-885-4953
Mailing Address - Fax:
Practice Address - Street 1:12620 BEACH BLVD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7130
Practice Address - Country:US
Practice Address - Phone:904-635-0777
Practice Address - Fax:904-545-3483
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily